Lifelong Arrhythmia supposedly benign

I'm a 50 Year Old Caucasian Male that has experienced PVC's (mostly) and PACs (few) since the age of 16. I now take Nadolol (52 BPM Resting Pulse), and Phenytek (for another problem), as well as Zocor, ASA,  and Diovan w/HCTZ. Typically, during any given year, I would experience bouts of the arrhythmia, to be followed by remission, and recurrence at some later date. The periods of time between the recurrence of the arrhythmia could be substantial, many many months of time when I was actually able to forget that I have a heart. Beginning last year, my arrhythmia appears to be here to stay. Since then I have had several Holters, a 30 day event monitor, a stress test (thallium or whatever the modern equivalent is), I am assured that all is well.

Previously my arrhythmia has manifested as Isolated PVCs and occasional PSVT (non-reentrant), but now my heart seem quite fond of running periods of arrhythmia ranging from Trigeminy to every 6 beats or so. For the most part, this may go on for several minutes, break, and then resume minutes to an hour later. Last night I had 4 hours of this without any breaks.

1. I have previous occupational exposures to Benzene over the last 10 years (sensitizes the myocardium to catecholamines) but have not been exposed within the last 1 1/2 Years (to any significant degree). Does the sensitized myocardium come only with acute exposures then dissipate, or does it have a lasting affect.

2. I have developed a rather nasty swallowing induced arrhythmia that only occurs in the evening, and have lost some 20 pounds of my original 290 pound weight since I now avoid eating as much. The arrhythmia is documented on the Holter. The Cardiologist is not concerned, believing that vagal enervation is causing the disorder. He has prescribed Paxil. I have some concern of Paxil causing an arrhythmia. Any comments on either aspect of this question.

3. At work while in confrontational meetings, my heart is plagued by continuous PVCs, yet minutes later when I relax, much of the normal rhythm is quickly recovered. Upon physical stress at work, walking fast, climbing several flights of stairs, my heart rhythm is usually quite normal, with PVCs occurring after my pulse begins to drop. This has been the case throughout my life, only it's much more persistent now. With a 52 BPM Resting Pulse, and a blood pressure that averages 130/85, why does the adrenaline still hold such sway with my rhythm, and is there a test for excess adrenaline or catecholamines that I should have?

Thanks much.

[Celeste77]

I'm an 23 year suffer of PVC's. Like you, I've had remissions lasting months and even years, but I have been plagued with them constantly since last year. It's not unusual for me to be in Bigeminy for hours at a time, followed by etopics every 6th beat or so. I rarely have an hour that I don't have any.

1. My father was exposed to Benzene (solvents) for 36 years, he's retired now. Thankfully, he hasn't experienced any of the nasty effects other then when he was working with it. However, his doctor does check yearly for signs of certain diseases that can manifest after long exposures to it.
The most common long-term health effects associated with benzene exposure are:
Aplastic anemia
Various forms of leukemia
Hodgkin’s Disease
Multiple Myeloma
Lymphomas
Myelofibrosis
Myelodysplastic Syndrome
I would think that the myocardium becomes less sensitive as time goes on and the exposure has ceased. Cigarettes contain Benzene, so hopefully you don't smoke or are not around other smokers often.

2. I also have vagal induced PVC's, although mine are not brought on my swallowing.
I know there are a few posters here that have suffered from the same thing you have, so you might want to search the archives for more info on how they handled it.
About Paxil; I took it years ago but won't touch it now. Anything that lists arrhythmia's as a possible side effect is off limits for me.  
If Phenytek was added last year, have you considered switching to something other then Phenytek for a short time to see if that helps to alleviate the constant arrhythmia's? It's #1 listed side effect is irregular heartbeats. (I took Depakote)

3. Just my thoughts: When it comes to adrenaline dumping in the body, I believe the most common cause besides stress, is functional or idiopathic postprandial hypoglycemia. Both cause adrenergic hypersensitivity and the adrenal gland begins dumping catecholamines into the blood system at the slighest trigger.
With functional hypoglycemia, the only way to test properly would be to test the GTT, the insulin levels and the adrenaline levels simultaneously, and that's just not standard protoccol. With Postprandial hypoglycemia blood levels drop only slightly, but the symptoms can be extreme.
After awhile adaptation mode kicks in and the body goes into a vicious cycle, ie, the body learns to dump more and more adrenaline at the slighest drop of glucose, physical or psychological stressor.

VMA (vanillylmandelic acid), urine metanephrines, plasma catecholamines, urine
Chromogranin A, and free urinary catecholamines testing is available, although it's normally reserved for those that have suspected Pheochromocytoma's of the adrenal gland. The best way to get the testing done would be to go to an Endocrinologist.

Just a side note: What's really ironic is that catecholamines have the same structure as a Benzene ring with two hydroxyl groups, an intermediate ethyl chain and a terminal amine group.

Hope you find some answers here, be well!

[Artaud]

Thank you for the extensive response. I can see I have more to research.

During my unenlightened stage of employment, two of my coworkers contracted diseases possibly related to Benzene. One died of a Liver Cancer that metastasized, the other developed Aplastic Anemia. Both were in their mid-30's, both worked in the same shop. One had 5 years in the plant, the other nearly 10. Unfortunately, the company controls the documentation, (i.e. the results of periodic monitoring), and assures us that the exposures are minimal. Despite this ludicrous claim, we have worked in areas where Benzene was spilling on the ground from leaks, suffusing the air with the vapor. Also, certain operations are not performed with the proper respect to other employees in the area. The facility where I work recently hired a new Industrial Hygienist. She found problems with some of the areas and exposures. I’m willing to bet that they will transfer her soon to another facility. The intent of this paragraph is to make people aware in this Forum that exposures to certain substances, i.e. solvents for one, can sensitize the heart to Catecholamines,  (epinephrine and norepinephrine, and dopamine). If you have solvent exposures, be sure to use ample ventilation and wear a respirator with cartridges appropriate for the exposure. ALSO, be aware that OSHA requires cartridges exposed to Benzene to be changed every 8 hours. We would wear ours for weeks. Humidity quickly adsorbs onto the carbon inside the cartridge, and eventually the Benzene will pass through without being filtered. Also, using a cartridge on a subsequent day may expose you to Benzene that has migrated through the cartridge over time. Solvent exposures could lead to or exacerbate arrhythmias.

I would appreciate it if someone could explain to me the correlation between MVP (which I have but the degree of which I am unsure), MVP Syndrome, and Arrhythmias. One cardiologist (years ago) said that I have MVP, the next said no, the current says I do have MVP. (I have not been jumping from one doctor to another, these Doctors were in various areas as I moved for employment). I did have, twice, occurrences of having a PVC, being short of breath, (taking rapid short breaths, nothing debilitating but more startling), only to have it go away after the occurrence of another PVC. Two incidents, each presenting in the same way, years apart, with just one occurrence of the shortness of breath each time. I have been told that this is from the MVP. I alternately read that MVP causes arrhythmias, only to find another medical site that says it doesn’t.

Lastly, my wife’s car, being driven by my son, was largely obliterated last night by a drunken driver that hit the rear of the car with his pickup truck. He was trying to evade the police, who had been called due to his erratic driving. He hit the rear of the car without even hitting his brakes, shoving the car far across the intersection. The rear end of the car, a Mercury Grand Marquis, was pushed up to the rear window, which had burst, sending glass throughout the interior of the car. The driver seat broke, flipping my son down onto the rear seat. If the pickup truck had extended into the back seat, it would have killed my son. The accident happened literally a stones throw away from the hospital. My son and wife walked there, he was seen (after much time) and released with a Neck Brace. My heart had been doing considerable PVCs since about 2:00 PM yesterday (long before the accident), and this was the icing on the cake. I returned home and waited for my wife to phone for a ride home from the hospital. My heart was a mess. I genuinely thought that I was going to need to go to the emergency room. I took .25 mg of Klonopin and settled at the computer, determined to do something routine to get the focus off of my heart and the accident. To my utter amazement, the arrhythmia finally broke, long before the Klonopin could have taken effect. Just mentally involving myself with a routine task (typing Meeting Minutes from work that needed to be done) seemed to be enough. I wish it was always that easy.

Best wishes to all. The forum helps me and I’m sure others to realize that we are not alone.

[Celeste77]

Thank goodness your son is ok! What a terrifying experience. As a mother, I can only imagine what you all went through. My thoughts are with you all.

I'm also sorry to hear about your co-workers. It's such an injustice and unfortunetly it happens all the time. Benzene is much more common place then many think. I'm thankful everyday that my father had some control over the job sites and wore the proper masks (most of the time) when working with it.

About MVP: According to my Cardiologist/EP, MVP can be just like PVC's. Coming and going in it's own accord. It is also said to be one of the most over-diagnosed conditions.
I had MVP in 1994 as shown on my echo. In 2000, there was no trace of it, but it reared it's head again just last year, thankfully, it's mild with minimul to no regurgitation.
It's symptoms vary from none at all to debilitating and may come and go also.

1. Irregular Heartbeat: This is sometimes felt as "fluttering" or palpitations. The patient may feel as if the heart "stops beating" for a moment. Sudden breathlessness or the urge to cough may be felt. Palpitations may be noticed when lying down at night, particularly when lying on the left side; such palpitations are almost always due to MVP.
2. Tachycardia: A sudden speeding up of both the heart rate or the pulse along with a pounding heartbeat are common symptoms of MVP.
3. Chest Pain: Chest pain is a common but poorly understood symptom of MVP. The pain may be sharp or dull, and it may last from a few seconds to several hours. Chest pain may occur at rest more than with exertion, and it may occur alone or with other MVP symptoms.
4. Panic Attack: Panic attack may be another symptom of MVP. A panic attack is a sudden feeling of intense anxiety or impending doom for no apparent reason. A panic attack may be mild or severe and disabling.

I experience all these symptoms and my Cardio feels its more the arrhythmia and anxiety itself, rather then the MVP. If my MVP was moderate to severe, he would feel differently and treat me more aggressively.

Like your experience yesturday, getting busy and doing something to distract myself often breaks my cycle of PVC's.
I'm always glad that my heart doesn't do well in keeping up the PVC's when it comes to my brain multi-tasking...lol. Actually, the sympathetic nerves (cardiovascular system, mediated catecholamines)  act as the accelerator and the parasympathetic nerves, cranial (brain) and sacral regions of the spinal cord act as the brake, so doing something that requires concentration makes alot of sense when it comes to slowing down the PVC's.

Take care, and best wishes to you and your family.

[Artaud]

Thanks ever so much for the information and the time it took to compile your response. I appreciate the extent of your posts.

I may be missing something though, what has happened to your profile? I have not seen you post recently.

[PVC man]

When I was younger and first got PVCs the first cardiologist I had said I had MVP. Subsequent better echos have shown I have none.

I read one excellent book on MVP and syndrome ("confronting Mitral Valve Prolapse Syndrome" by Lynn Fredrickson- available from Amazon) where she talks about people with MVP having dysautonia, an imbalance of the nervous system.  Although I do not have MVP, I DO feel that I have some mild form of a dysautonia which explains some physical symptoms, including PVCs).

So I feel that even though we may/may not have MVP, we DO share a lot of the same issues with these patients.

Be well.